Spectral domain optical coherence tomography for early detection of retinal alterations in patients using hydroxychloroquine

Yigit, Ulviye; Tuğcu, Betül; Nur, Tarakcioglu Hatice; Çelik, Selda

doi:10.4103/0301-4738.112161

Cited by 27 publications

(25 citation statements)

References 22 publications

(27 reference statements)

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“…The perifoveal quadrants were not widely affected, but the temporal quadrant showed maximal affection. Significant loss of perifoveal retinal thickness has been reported in preclinical hydroxychloroquine maculopathy in some studies [ 18 , 22 ], but this was not found in our group of patients. The extent of damage in the macular area is thought to be related to ganglion cell distribution, as suggested by primate studies [ 14 ].…”

Section: Discussioncontrasting

confidence: 72%

“…The extent of damage in the macular area is thought to be related to ganglion cell distribution, as suggested by primate studies [ 14 ]. Furthermore, the binding of Chloroquine to melanin pigment in the RPE and presence of an avascular zone at the center of the fovea has been suggested as a possible explanation for the distribution of damage [ 22 ]. Fundus autofluorescence is sensitive to areas of RPE loss even in very early stages, showing alternating rings of central mottled hypoautofluorescence and pericentral mottled hyperautofluorescence [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

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Spectral-Domain Optical Coherence Tomography of Preclinical Chloroquine Maculopathy in Egyptian Rheumatoid Arthritis Patients

Allam

Elmohsen

Khafagy

et al. 2015

Journal of Ophthalmology

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Purpose. To evaluate the role of spectral-domain optical coherence tomography (SD-OCT) in early detection of Chloroquine maculopathy in rheumatoid arthritis (RA) patients. Methods. 40 left eyes of 40 female rheumatoid arthritis patients who received treatment chloroquine for more than one year were recruited in the study. All patients had no symptoms or signs of Chloroquine retinopathy. They were evaluated using SD-OCT, where the Central Foveal Thickness (CFT), parafoveal thickness and perifoveal thickness, average Retinal Nerve Fiber Layer (RNFL) thickness, and Ganglion Cell Complex (GCC) measurements were measured and compared to 40 left eyes of 40 normal females. Results. The mean CFT was found to be thinner in the Chloroquine group (238.15 µm ± 22.49) than the normal controls (248.2 µm ± 19.04), which was statistically significant (p value = 0.034). The mean parafoveal thickness was lesser in the Chloroquine group than the control group in all quadrants (p value <0.05). The perifoveal thickness in both groups showed no statistically significant difference (p value >0.05) in all quadrants. No significant difference was detected between the two groups regarding RNFL, GCC, or IS/OS junction. Conclusions. Preclinical Chloroquine toxicity can lead to early thinning in the central fovea as well as the parafoveal regions that is detected by SD-OCT.

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Section: Discussioncontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Spectral-Domain Optical Coherence Tomography of Preclinical Chloroquine Maculopathy in Egyptian Rheumatoid Arthritis Patients

Allam

Elmohsen

Khafagy

et al. 2015

Journal of Ophthalmology

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“…This suggests an acceleration of thinning in the inferior outer ring as toxicity progresses. Interestingly, two other studies have noted the inferior macula may be the earliest affected quadrant in HCQ toxicity, but further studies are needed [18, 20]. Finally, this study included myopic eyes up to −6D.…”

Section: Discussionmentioning

confidence: 99%

Expanded spectral domain-OCT findings in the early detection of hydroxychloroquine retinopathy and changes following drug cessation

et al. 2016

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PurposeTo report expanded SD-OCT findings of HCQ retinopathy that may assist the clinician in earlier diagnosis. To characterize structural changes of HCQ retinopathy with SD-OCT after drug cessation.MethodsSetting: Private practice and academic institution. Patient Population: Patients at New England Eye Center and Ophthalmic Consultants of Boston in Boston, MA diagnosed with HCQ retinopathy and followed after drug cessation. Retrospective clinical data review by the Boston Image Reading Center. Main Outcome Measures: SD-OCT findings suggestive of HCQ retinopathy before parafoveal ellipsoid disruption. Change in SD-OCT morphological appearance and retinal thickness of each of the nine subfields corresponding to the Early Treatment of Diabetic Retinopathy Study areas.ResultsThirty eyes with HCQ retinopathy were followed with SD-OCT after drug cessation. Findings before disruption of the parafoveal EZ included parafoveal outer nuclear layer (ONL) thinning, disruption of the parafoveal interdigitation zone, and reduced reflectivity of the parafoveal EZ. In early toxicity, 75 % developed progression after drug cessation, including disruption of the parafoveal EZ and retinal pigment epithelium and thinning of the ONL. Eyes with obvious toxicity had greater inferior outer ring thinning 12 months after drug cessation compared to early toxicity (p = 0.002, 95 % CI −2 to −8 μm). In obvious toxicity, the nasal inner subfield showed more thinning than the temporal inner subfield at 12 months after drug cessation (p = 0.018, 95 % CI −1 to −8 μm).ConclusionsOnce HCQ retinopathy is diagnosed and the medication is discontinued, structural retinal changes commonly occur.

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“…We also could not identify inner retinal thinning during 25 to 52 months of follow-up of short-or longterm users, including the patient who developed retinopathy. Cirrus data from other studies of the inner retina [3][4][5]13 may have been influenced by errors in CGCA measurements when the outer retina was abnormal, [6][7][8] as shown in Figure 3B. One report 13 found major inner retinal loss in select cases with severe toxic effects, but the investigators also used Cirrus analysis.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Inner and Outer Retinal Thickness in Patients Using Hydroxychloroquine Prior to Development of Retinopathy

Sisternes

Rubin

et al. 2016

JAMA Ophthalmol

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IMPORTANCE Retinopathy is a known risk of long-term use of hydroxychloroquine sulfate. However, whether the inner as well as outer retina are involved before retinopathy develops and whether changes in the retina might signal impending toxic effects during screening remain unknown. OBJECTIVE To determine the degree of inner and outer retinal involvement in short-and long-term use of hydroxychloroquine before the development of retinopathy. DESIGN, SETTING, AND PARTICIPANTS This retrospective medical record review of spectral-domain optical coherence tomography (SD-OCT) findings was performed at an academic medical center. Thirty-two patients without retinopathy and with high-quality SD-OCT images were studied. Twenty-seven patients were age matched (49-65 years old) for comparison of retinal layers among patients who used the drug less than 5 years (n = 12) or longer than 15 years (n = 15) at the initial visit. Populations were also defined (without age limitation) for comparison of change during 25 to 52 months of follow-up among patients with initial use of less than 5 years (n = 7) or longer than 15 years (n = 8). Data were collected from 2010 to 2015. MAIN OUTCOMES AND MEASURES Measurements of inner and outer retinal thickness in SD-OCT images using commercial software and a Stanford pixel-by-pixel segmentation software that also provided topographic maps of thickness dimensions and change. RESULTS Thirty-two patients (5 men and 27 women) were included in the analysis. Measurements of inner retinal thickness between short-and long-term hydroxychloroquine users (n = 27) in different retinal regions, and during a median 39 months of follow-up (n = 15), showed no statistically significant differences or change. Similarly, no significant differences or changes were identified in outer retinal thickness except for the final visit of 1 patient who developed focal parafoveal thinning, a toxic effect of hydroxychloroquine use. Cirrus ganglion cell analysis measurements were inaccurate in the presence of outer retinal damage. CONCLUSIONS AND RELEVANCE The inner retina appears not to be involved in hydroxychloroquine-induced retinopathy to any clinically relevant degree within the limitations of our sample size. No clinically apparent warning of outer retinal damage was seen in the SD-OCT images of long-term hydroxychloroquine users until the actual appearance of focal retinopathy. Early detection of hydroxychloroquine-induced retinopathy is known to prevent visual acuity loss and serious progression after the therapy is stopped, and these data suggest that screening should seek distinct new areas of retinopathy (shown by topographic thickness maps) rather than long-term progressive thinning.

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Spectral domain optical coherence tomography for early detection of retinal alterations in patients using hydroxychloroquine

Cited by 27 publications

References 22 publications

Spectral-Domain Optical Coherence Tomography of Preclinical Chloroquine Maculopathy in Egyptian Rheumatoid Arthritis Patients

Spectral-Domain Optical Coherence Tomography of Preclinical Chloroquine Maculopathy in Egyptian Rheumatoid Arthritis Patients

Expanded spectral domain-OCT findings in the early detection of hydroxychloroquine retinopathy and changes following drug cessation

Analysis of Inner and Outer Retinal Thickness in Patients Using Hydroxychloroquine Prior to Development of Retinopathy

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